How to Navigate Insurance Coverage for Autism Therapy in Tennessee

Does Insurance Cover Autism Evaluations and ABA Therapy in Tennessee?

Understanding insurance coverage for autism therapy in Tennessee is not easy. Understanding the specifics of your insurance plan is crucial for accessing the necessary services and support for your child.

Sometimes that is easier said than done, but we’re here to help. In this piece, our Hopebridge Care and Benefits team dives into some of the most common questions related to insurance coverage for autism therapy in Tennessee.

What specific autism services does the insurance plan cover?

The coverage for autism services can vary among insurance plans. It’s essential to review your insurance policy to identify the specific services covered. Common services may include diagnostic assessments, therapeutic interventions like applied behavior analysis (ABA), and other related treatments or services. When determining your plan’s benefits, look for detailed information on behavioral health or mental health coverage within your policy. This can usually be found in the Member Handbook or Evidence of Coverage (EOC) issued by your health plan.

Are diagnostic evaluations for autism spectrum disorder (ASD) covered by the insurance?

Diagnostic assessments are often a crucial first step in the journey of autism therapy. Many insurance plans cover the cost of autism testing, but not all. For instance, United Heathcare (UHC / Optum) does not cover diagnostic testing at Hopebridge, but does cover ABA services with us. Check your policy to confirm coverage details, including any requirements for pre-authorization or referrals. 

What types of therapies for autism are covered, such as ABA, speech therapy, or occupational therapy?

The coverage of therapies for autism varies, and it’s important to know which therapies are included in your insurance plan. Common therapies include applied behavior analysis (ABA therapy), speech and language therapy and occupational therapy. Review the policy for specific details on covered therapies, as well as any limitations or restrictions. It’s not uncommon for insurance companies to have separate requirements for behavioral health and physical health benefits. When checking requirements for coverage, be sure to review for ABA separately from speech and occupational therapy.  

What are the best insurance companies in Tennessee for ABA therapy and other autism services?

Insurance companies offer a range of plans for different needs and families should choose the option that works best for their family. In Tennessee, Hopebridge works with Aetna, Ambetter, Ascension Personalized Care TN, BlueCare MCD TN, Blue Cross Blue Shield (BCBS), Cigna (Evernorth Behavioral Health), Humana Behavioral Health, Meritain Health, UHC United Healthcare, UHC United Healthcare Community Plan Medicaid and Wellpoint Medicaid for coverage of autism services.

How much is an autism diagnosis with insurance?

Autism testing is typically included within the benefits provided by the insurance companies we work with in Tennessee. Hopebridge will bill the insurance company on your behalf. From there, your child’s specific plan will determine any contracted discounts or out-of-pocket costs.

How much does ABA cost?

The cost of applied behavior analysis (ABA therapy) can vary based on several factors, including the specific services required, duration of treatment and terms of the individual insurance plan. Like our diagnostic services, Hopebridge will bill the insurance company on your behalf, and your child’s specific plan will determine any contracted discounts or out-of-pocket costs. Payment plans may also be available to you.

Is there a limit on the number of therapy sessions or hours covered per week or per year?

Insurance plans may impose limits on the number of therapy sessions or hours covered. Understanding these limits is crucial for planning your child’s therapy schedule. Check your policy for details on session limits and any process for obtaining additional sessions, if needed. 

Are medications related to autism treatment covered by the insurance?

Hopebridge does not prescribe medication, but some children with autism may have medications deemed medically necessary as part of their treatment plan. Check your insurance policy to see if it covers the cost of medications related to autism treatment. This may include medications for co-occurring conditions such as anxiety or attention deficit hyperactivity disorder (ADHD).

Does the insurance cover assistive devices or tools that may benefit my child with autism?

Assistive devices and tools, such as communication devices or sensory tools, can be essential for children with autism. Some insurance plans may provide coverage for durable medical equipment (DME) or assistive technology. Since the benefits between plans can vary, even between the same insurance provider, review your specific policy to see if it covers the cost of these devices and for network participation status.

Are there any age restrictions for autism coverage under the insurance plan?

Insurance plans may have age restrictions for autism coverage. Some plans may cover autism services only up to a certain age. Verify the age limitations specified in your policy to ensure continuous coverage for your child.

What Insurance Coverage for Autism Therapy Means for Your Family

Understanding the intricacies of insurance coverage for autism therapy in Tennessee empowers parents to advocate effectively for their children. We recommend you regularly review your child’s policy, stay informed about any changes and communicate with your insurance provider to ensure that your child receives the comprehensive care they need. By being proactive, families can navigate the complexities of insurance coverage and provide the best support for their children on the autism spectrum.

To get autism testing and ABA therapy support for your child, contact us at Hopebridge Autism Therapy Centers. Our Care and Benefits Coordinators will work with you to confirm your benefits and insurance coverage, obtain any necessary authorizations and inform you of any out-of-pocket costs. We’re here to guide you through the process so you can put your focus on your child and get them the extra care that they deserve.

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